Prediction of cerebral palsy in very low birth weight preterm infants: a comparative study between cranial ultrasound and brain MRI

This prospective study was carried out in the neonatal intensive care unit, El-Minia university hospital. Two diagnostic modalities, serial cranial ultrasound [US] scans and brain magnetic resonance imaging [MRI] were performed once at near term on 38 very premature infants, "less than 32 weeks gestation" [20 males and 18 females] with very low birth weight [< 1500 g]. The aim was to compare both diagnostic modalities in identification of different brain injuries such as periventricular leucomalacia and intraventricular hemorrhage and to assess their value in early prediction of cerebral palsy [CP]. Infants were followed up by neurorehabilitation service up to 20 months corrected age, when all cases of CP can be diagnosed clinically. In the first group [8 patients with CP], MRI findings predicted CP cases with 87.3% sensitivity and positive predictive value of 70%. The corresponding figures for cranial US were 50% and 44.4% respectively. In the other group [30 infants without CP or with minor neurological abnormalities], MRI findings predicted neurologically normal infants [i.e. without CP] with 90% specificity and negative predictive value of 96.4%. The corresponding figures for cranial US being 83.3% and 86.2% respectively. It can be concluded that, though MRI is superior to cranial US for early prediction of CP; cranial US is still being used as a repeatable easy bed side diagnostic modality to demonstrate severe parenchymal lesions. MRI can be reserved for subtle lesions or cases with normal or controversial result by cranial US

impact of sonography and Alvarado score on the clinical management of patients with acute appendicitis

Purpose: To determine whether diagnosis by graded compression ultrasonography improves clinical outcome for patients with suspected acute appendicitis. Material and A total of 180 patients suspected to have acute appendicitis were included in the study. 90 patients were randomized to the intervention group and were subjected to a diagnostic protocol incorporating ultrasonography and the Alvarado score. A control group included 90 patients in whom the standard clinical management was applied. The appendix was visualized at US in 69 of 83 patients [83%]. Sensitivity, specificity and accuracy of ultrasound in the diagnosis of acute appendicitis were measured at 92%, 90% and 91% respectively. Patients in the intervention group had a statistically significant lower number of both non-therapeutic operations and perforated appendix. There was no statistically significant difference in between groups in the total number of operations performed. Graded compression sonography is a powerful imaging tool that substantially improves diagnostic accuracy in patients with clinically equivocal appendicitis

Non-enhanced helical CT: Its impact on diagnosis of acute flank pain due to urolithiasis

Purpose: To evaluate the impact of nonenhanced helical computed tomography on the diagnosis of acute flank pain due to urolithiasis. Material and The study included 247 consecutive patients complaining of acute loin pain. Their ages ranged from 16 to 67 years with a mean age of 23 years. Sixty-seven patients were females and 180 were males. Patients were referred to the radiology department for plain radiography and Ultrasonography for the urinary tract. Of these patients, 193 were selected to have helical nonenhanced CT scan for the urinary tract. A total of 413 urolithiasis were detected by NHCT in the 193 patients. Of these calculi, 22% were detected only by CT scan and were not seen on plain radiography. The proximal ureter was the commonest site of stone lodgment. The CT findings for urinary tract stones causing obstructive uropathy were perirenal permeation in [63%], tissue rim sign due to impacted ureteric stone with surrounding oedema in [56%], and the tail sign of phleboliths in [18%] of cases. Other pathologies were identified as a cause of flank pain resembling that of acute renal colic in 22 patients; ovarian cyst in 12 patients [6.2%] and acute appendicitis in 10 patients [5.2%]. - Nonenhanced helical computed tomography can detect all the urinary tract stones including those not seen on plain radiography with unprecedented sensitivity and specificity. The technique can also detect causes for flank pain outside the genitourinary tract